Introduction

Neurological disorders requiring surgical intervention from brain tumors and vascular lesions to degenerative spinal disease carry unique systemic and neurological risks [1]. Small variations in fluid balance, hemodynamics, ventilation, drug management, and neurological monitoring profoundly influence surgical outcomes [2]. This review provides a structured overview of the essential components of perioperative medical and nursing care, with emphasis on the pivotal role of nurses in monitoring, complication prevention, patient/family education, and coordination of care [3]. Neurological diseases represent some of the most challenging conditions in modern medicine, not only due to their complexity but also because of the profound and often lifelong impact they exert on patients’ quality of life [4]. Disorders such as brain tumors, cerebrovascular accidents, traumatic brain injuries, epilepsy, neurodegenerative diseases, and spinal cord disorders frequently necessitate surgical interventions as part of comprehensive treatment. These interventions, however, are associated with significant risks and complications that extend beyond the surgical act itself. Consequently, perioperative medical and nursing care encompassing both pre-operative and post-operative phases plays a pivotal role in determining patient outcomes, recovery trajectories, and long-term prognosis. A systematic understanding of best practices in this domain is therefore critical to ensure safety, improve survival rates, and enhance the quality of life for individuals affected by neurological diseases [5].

Burden of Neurological Diseases and the Need for Surgery

The global burden of neurological diseases is considerable, accounting for a substantial proportion of disability-adjusted life years (DALYs) and mortality worldwide.

According to the World Health Organization, neurological disorders are among the leading causes of disability and death, with conditions like stroke and traumatic brain injury contributing significantly to healthcare costs and societal burden. While pharmacological and rehabilitative treatments remain essential, surgical interventions such as tumor resections, decompressive craniotomy, aneurysm clipping, spinal surgeries, and epilepsy surgery are often indispensable. Given the invasive nature of these procedures, effective perioperative care is fundamental to reducing complications, optimizing recovery, and facilitating rehabilitation [6].

Importance of Perioperative Care

Perioperative care for neurological patients is uniquely complex, as it must address not only standard surgical considerations such as anesthesia, infection control, and hemodynamic stability, but also disease-specific factors including intracranial pressure management, seizure prevention, neurocognitive function preservation, and rehabilitation planning. Pre-operative preparation is essential to reduce patient anxiety, assess risks, and optimize comorbid conditions such as hypertension, diabetes, or anticoagulation therapy. Similarly, post-operative management is critical to detect and prevent complications like cerebral edema, hemorrhage, seizures, and infections, while also promoting functional recovery through early mobilization and rehabilitation strategies.

Nursing care is particularly vital in this continuum. Nurses are often the first to recognize subtle neurological changes, ensure adherence to protocols, and provide emotional support to patients and families. Their role in patient education, psychological reassurance, and discharge planning is also crucial for long-term recovery.

The integration of medical and nursing perspectives therefore creates a holistic approach that addresses the biological, psychological, and social dimensions of neurological care [7].

Pre-operative Considerations

Pre-operative care begins with a comprehensive neurological assessment, including imaging studies, cognitive evaluation, and functional assessments, to establish a baseline for comparison after surgery. Optimization of comorbid conditions is vital: hypertension and diabetes must be controlled, anticoagulant or antiplatelet therapy adjusted, and nutritional deficiencies corrected. Furthermore, psychological preparation including counseling and education about the surgical procedure has been shown to reduce anxiety and improve compliance with post-operative care instructions. In certain neurological conditions, such as epilepsy, the adjustment of anticonvulsant medication is crucial to prevent perioperative seizures. Patient-centered communication, involving both patients and their families, is an integral part of this process, fostering trust and improving adherence to medical advice [8].

Intraoperative Challenges and Nursing Role Although the intraoperative period is primarily the domain of surgeons and anesthesiologists, perioperative nurses play an indispensable role in ensuring safety and continuity of care. Their responsibilities include monitoring vital signs, preparing necessary equipment, maintaining aseptic conditions, and anticipating the needs of the surgical team. Importantly, intraoperative nursing vigilance helps in the prevention of complications such as hypoxia, hypotension, and surgical site infection. Moreover, neurosurgical procedures often involve advanced technologies such as intraoperative imaging, neuronavigation, and electrophysiological monitoring, requiring specialized training and competence among the nursing team [9].

Post-operative Considerations

The post-operative phase is often the most critical in determining neurological and functional outcomes. Immediate post-operative care typically involves close monitoring in the intensive care unit or specialized neurosurgical wards, where early recognition of complications such as hemorrhage, cerebral edema, hydrocephalus, or infections is paramount. Neurological assessments often conducted hourly in the first 24 hours are crucial for identifying deterioration. Pain management, wound care, and prevention of complications such as deep vein thrombosis, pulmonary embolism, or pressure ulcers are also essential components of post-operative care [10].

Nursing care during this phase extends beyond physiological monitoring. Emotional support for patients and families is critical, especially in cases where the surgery may result in neurological deficits such as speech impairment, hemiparesis, or cognitive decline. Rehabilitation planning including physiotherapy, occupational therapy, and speech therapy should begin as early as possible to maximize functional recovery. The nurse often acts as a coordinator between different specialties, ensuring that patients receive comprehensive and timely interventions [11].

Multidisciplinary Collaboration

One of the most significant themes emerging in modern perioperative neurological care is the emphasis on multidisciplinary collaboration. Neurosurgeons, anesthesiologists, intensivists, neurologists, physiotherapists, psychologists, and specialized nurses must work in close coordination to address the multifaceted needs of patients. This collaborative approach has been shown to reduce complication rates, shorten hospital stays, and improve overall patient satisfaction. Nursing professionals, in particular, often bridge the communication between patients, families, and the medical team, facilitating holistic care that addresses both clinical and psychosocial dimensions [12].

 Gaps in Current Practice

Despite advances in neurosurgical techniques and perioperative protocols, significant gaps remain in the standardization of care practices. Variation in nursing protocols, inconsistent application of evidence-based guidelines, and limited resources in low- and middle-income countries hinder optimal patient outcomes. Moreover, psychological and social support though increasingly recognized as critical remains underemphasized in many clinical settings. There is also a need for more robust training programs for nursing staff, especially in resource-limited environments, where specialized neurosurgical nursing expertise may be scarce. Given the complexity of neurological diseases and the critical role of perioperative care, a systematic review is necessary to synthesize current evidence and provide guidance for both clinicians and nurses. While numerous studies have addressed specific aspects of pre- and post-operative management, there remains a lack of comprehensive analysis that integrates medical and nursing perspectives across a wide range of neurological conditions. This review therefore seeks to bridge this gap by critically evaluating the literature, identifying best practices, and highlighting areas for future research [13].

The primary objective of this systematic review is to evaluate and synthesize evidence on medical and nursing care strategies for patients with neurological diseases during the pre- and post-operative periods. Specifically, the review aims to:

• Identify key pre-operative interventions that optimize surgical outcomes and reduce complications.
• Examine post-operative care practices that promote recovery, prevent adverse events, and improve quality of life [14].
• Assess the role of multidisciplinary collaboration, with particular emphasis on the contributions of nursing care.
• Highlight gaps in current practice and propose recommendations for future research and clinical protocols.

Neurological diseases present unique challenges that extend beyond surgical interventions, requiring careful attention to perioperative care. Medical and nursing teams play complementary roles in preparing patients for surgery, safeguarding intraoperative stability, and promoting post-operative recovery [15]. This systematic review provides an evidence-based exploration of these practices, offering insights into strategies that can improve patient safety, recovery outcomes, and overall quality of life. By integrating medical and nursing perspectives, this review contributes to the development of comprehensive and patient-centered approaches in the care of individuals undergoing neurosurgical interventions [16].

Methodology (PRISMA Framework)

• Research Question (PICO):

• Population: Adults and children undergoing neurosurgical procedures.
• Interventions: Medical and nursing perioperative care, ERAS pathways, preventive strategies.
• Comparison: Standard or alternative protocols [17].
• Outcomes: Mortality, complications (infection, VTE, seizure, hemorrhage, CSF leak, dysphagia/aspiration, delirium), length of stay, functional recovery.

• Sources: PubMed/MEDLINE, Embase, Cochrane Library, CINAHL, society guidelines.
• Inclusion Criteria: Reviews, guidelines, RCTs, and observational studies focused on perioperative neurosurgical care.
• Exclusion Criteria: Low-quality studies, unrelated conditions, case reports (except rare diseases).
• Quality Assessment: AMSTAR (reviews), Cochrane risk-of-bias (RCTs), NOS (observational studies).

In figure (1), PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only was illustrated.

Table 1: PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only

Pre-operative Considerations

Comprehensive Assessment and Risk Stratification:

• Neurological exam: Glasgow Coma Scale (GCS), focal deficits, speech/swallow function, signs of intracranial hypertension.
• Risk scores: ASA, Revised Cardiac Risk Index (RCRI); NIHSS for stroke, Hunt–Hess/WFNS for subarachnoid hemorrhage (SAH).
• Labs: CBC, electrolytes (with focus on sodium), glucose, renal/liver function, coagulation profile.
• Optimization of comorbidities: Hypertension, diabetes, COPD, heart failure, chronic kidney disease.

In table (1), comprehensive assessment and risk stratification in neurological surgical patients (Hypothetical Data) was illustrated.

Table 1. Comprehensive Assessment and Risk Stratification in Neurological Surgical Patients (Hypothetical Data)

Medication Management

Antiplatelet/anticoagulants: Timing of discontinuation/bridging based on bleeding risk.

• Antiepileptic’s (AEDs): Continuation to prevent perioperative seizures.
• Corticosteroids (e.g., dexamethasone for tumors): Used to reduce edema; monitor for hyperglycemia.
• Glucose control: Moderate targets (140–180 mg/dL).
• Antibiotic prophylaxis: Administered per surgical guidelines [18].

In table (2), medication management in neurological surgical patients (Hypothetical Data) was illustrated.

Table 2. Medication Management in Neurological Surgical Patients (Hypothetical Data)

Anesthetic and Intraoperative Strategies

• Airway/ventilation: Secure airway, normocapnia; avoid extremes of CO₂.
• Hemodynamics/fluids: Maintain cerebral perfusion pressure (CPP); isotonic crystalloids; avoid hyponatremia [19].
• Positioning: Minimize nerve/pressure injury; monitor for air embolism risk in sitting/craniotomy positions.

In table (3), anesthetic and intraoperative strategies in neurological surgeries (Hypothetical Data) was illustrated.

Table 3. Anesthetic and Intraoperative Strategies in Neurological Surgeries (Hypothetical Data)

Patient/Family Education

• Clear communication of risks, pain plan, nutrition/swallowing expectations, rehabilitation trajectory.
• Cultural sensitivity and psychosocial support for elderly or cognitively impaired patients [19].

In table (4), patient/family education strategies in neurological surgery (Hypothetical Data) was illustrated.

Table 4. Patient/Family Education Strategies in Neurological Surgery (Hypothetical Data)

Post-operative Considerations

Neurological and Systemic Monitoring:

• Frequent neuro checks: GCS, pupils, motor/sensory, speech.
• Head elevation at 30°, neutral neck positioning.
• ICP monitoring (external ventricular drain [EVD]) where indicated [20].
• Hemodynamic targets: Tailored to pathology (e.g., strict BP control after aneurysm clipping/coiling).
• Ventilation: Avoid hypoxia; assess extubation readiness early.

In table (5), neurological and systemic monitoring in post-operative neurological patients (Hypothetical Data) was illustrated.

Table 5. Neurological and Systemic Monitoring in Post-Operative Neurological Patients (Hypothetical Data)

Prevention of Major Complications

• Seizures: Continue AEDs; EEG in high-risk patients.
• VTE: Sequential compression devices, stockings, early ambulation; pharmacologic prophylaxis when safe.
• Surgical site infection/meningitis: Strict asepsis with drains/catheters; wound care.
• Electrolyte imbalance: Careful monitoring of sodium differentiate SIADH vs. cerebral salt wasting.
• Hyperglycemia: Tight but safe glycemic control [21].
• Skin integrity: Prevent pressure ulcers with repositioning and protective surfaces.

In table (6), prevention of major post-operative complications in neurological surgery (Hypothetical Data) as illustrated.

Table 6. Prevention of Major Post-Operative Complications in Neurological Surgery (Hypothetical Data)

Pain and Sedation Management

• Multimodal analgesia: Acetaminophen, gabapentinoids, low-dose opioids.
• Avoid over sedation to permit accurate neuro exams [22].

In table (7), pain and sedation management in neurological surgery (Hypothetical Data) was illustrated.

Table 7. Pain and Sedation Management in Neurological Surgery (Hypothetical Data)

Nutrition, Swallowing, and Aspiration Prevention

• Early dysphagia screening before oral intake.
• Initiate enteral feeding within 24–48h in ICU patients.
• Oral hygiene to reduce ventilator-associated pneumonia [23].

In table (8), nutrition, swallowing, and aspiration prevention in post-operative neurological patients (Hypothetical Data) was illustrated.

Table 8. Nutrition, Swallowing, and Aspiration Prevention in Post-Operative Neurological Patients (Hypothetical Data)

Rehabilitation and Discharge Planning

• Early mobilization: Sitting, standing, walking as tolerated.
• PT/OT/ST for functional/cognitive recovery.
• Family education: Wound care, seizure precautions, and red-flag symptoms [24].

In table (9), rehabilitation and discharge planning in neurological surgery (Hypothetical Data) as illustrated.

Table 9. Rehabilitation and Discharge Planning in Neurological Surgery (Hypothetical Data)

Disease-Specific Care

• Brain Tumors: Steroids pre-op; seizure monitoring post-op; radiation/chemo planning.
• SAH/AVM: Vasospasm prevention (nimodipine, TCD monitoring); maintain euvolemia.
• Trauma/TBI: Maintain CPP; osmotic therapy (mannitol, hypertonic saline); seizure prophylaxis.
• Spinal Surgery: ERAS protocols; early ambulation; wound/drain care [25].
• Epilepsy Surgery/DBS: Medication adjustment; neuropsychiatric support.
• Elderly: Delirium prevention; cautious fluid/medication use.
• Pediatrics: Careful fluid/pain control; parental engagement [26].

In table (10), disease-specific care in neurological surgery (Hypothetical Data) as illustrated.

Table 10. Disease-Specific Care in Neurological Surgery (Hypothetical Data)

Nursing Roles in Neurosurgical Care

• Structured neurological assessments.
• Execution of complication prevention bundles (VTE, SSI, pressure injuries, falls).
• Device management (EVD, shunts, drains) with aseptic technique.
• Pain/sedation titration with neuro exam compatibility.
• Dysphagia screening and nutrition safety [27].
• Coordination of rehabilitation and discharge planning.
• Emotional and psychological support for patients/families [28].

In table (11), nursing roles in neurosurgical care (Hypothetical Data) was illustrated.

Table 11. Nursing Roles in Neurosurgical Care (Hypothetical Data)

ERAS Pathways in Neurosurgery/Spine Surgery

• Patient engagement and education.
• Nutritional optimization and reduced fasting.
• Multimodal analgesia with opioid-sparing [29].
• Early extubation and mobilization.
• Continuous monitoring and quality improvement.

In table (12), ERAS pathways in neurosurgery/spine surgery (Hypothetical Data) was illustrated.

Table 12. ERAS Pathways in Neurosurgery/Spine Surgery (Hypothetical Data)

Discussion

The management of patients with neurological diseases undergoing surgical interventions requires a highly coordinated approach involving both medical and nursing care. A systematic review of the literature highlights several key domains that influence patient outcomes, including comprehensive preoperative assessment, perioperative risk stratification, disease-specific interventions, and post-operative monitoring and rehabilitation [30].

Preoperative Assessment and Risk Stratification are foundational to optimizing surgical outcomes in neurological patients. Patients often present with complex comorbidities such as hypertension, diabetes, or cardiovascular disease that can exacerbate perioperative risk. Comprehensive assessment involves neurological evaluation, laboratory and imaging studies, and assessment of systemic conditions, along with consideration of cognitive function, mobility, and nutritional status. Risk stratification tools facilitate individualized care plans, allowing clinicians to anticipate complications and implement targeted interventions. Nursing roles are critical at this stage, providing patient education, anxiety reduction, and preparation for adherence to perioperative protocols [31].

Medication Management represents another critical pre- and post-operative consideration. In neurological patients, the continuation, adjustment, or temporary cessation of disease-specific medications such as antiepileptic’s, anticoagulants, or dopaminergic agents is essential. For example, abrupt discontinuation of antiepileptic drugs can precipitate seizures, whereas uncontrolled anticoagulation increases the risk of intraoperative bleeding [32]. Nursing vigilance in monitoring medication administration, adjusting doses according to renal or hepatic function, and educating patients and families about adherence is vital for preventing adverse outcomes [33].

Anesthetic and Intraoperative Strategies are tailored to the neurological condition and surgical procedure. Total intravenous anesthesia (TIVA) is frequently preferred for procedures requiring neurophysiological monitoring, whereas awake craniotomy demands careful sedation while preserving patient responsiveness for intraoperative mapping. Intraoperative monitoring—including ICP, cerebral perfusion pressure, EEG, and somatosensory evoked potentials—enables real-time adjustment of anesthetic depth and physiological parameters, minimizing the risk of neurological compromise. Nurses assist anesthesiologists by ensuring continuous monitoring, documenting events, and anticipating equipment or medication needs [34].

Post-operative Nursing Care and Monitoring are pivotal in detecting early complications. Neurological deterioration can be subtle [35], manifesting as changes in GCS, pupillary response, or motor function. Nurses conduct frequent neuro checks, monitor systemic parameters such as BP, SpO₂, and temperature, and implement early interventions for elevated ICP, infection, or hemodynamic instability. Disease-specific considerations, including seizure prophylaxis, cerebral edema management, or motor rehabilitation, require both vigilance and interdisciplinary coordination. Moreover, patient and family education regarding signs of deterioration, medication adherence, and lifestyle modifications supports safe recovery after discharge [36].

Pain, Sedation, and Nutrition Management also influence post-operative recovery. Pain control must balance analgesic efficacy with preservation of neurological assessment, often utilizing multimodal analgesia and opioid-sparing strategies. Sedation must be carefully titrated, particularly in patients at risk of elevated ICP or post-operative delirium. Dysphagia is common in stroke and cranial surgery patients, necessitating careful swallowing assessments, dietary modifications, and aspiration prevention. Nurses play a central role in monitoring intake, implementing precautions, and coordinating with dietitians and speech therapists [37].

Rehabilitation and Discharge Planning are integral to functional recovery. Early initiation of physical, occupational, and speech therapy is associated with improved mobility, independence in activities of daily living, and quality of life. Discharge planning involves comprehensive patient and caregiver education, provision of home-based support resources, and coordination of outpatient follow-up, including rehabilitation, neurological evaluation, and medication management. This collaborative approach ensures continuity of care and reduces the risk of readmission or complications.

Finally, the integration of ERAS principles in neurosurgical and spine surgery has emerged as an effective strategy to enhance recovery, minimize complications, and shorten hospital stay. Preoperative optimization, minimally invasive techniques, multimodal analgesia, early mobilization, and standardized post-operative care pathways exemplify evidence-based approaches that improve patient outcomes.

In conclusion, effective management of neurological surgical patients is multifactorial, requiring meticulous preoperative assessment, individualized perioperative interventions, vigilant post-operative monitoring, and structured rehabilitation. Nurses are central to the implementation of these practices, bridging the gap between medical decision-making and patient-centered care. A systematic, evidence-based, and interdisciplinary approach not only enhances clinical outcomes but also promotes patient safety, functional recovery, and satisfaction. Future research should focus on evaluating the efficacy of standardized protocols, exploring novel monitoring strategies, and optimizing education programs for both patients and caregivers.

Conclusion

Effective care for patients with neurological diseases undergoing surgery is complex and multifaceted, requiring meticulous coordination between medical and nursing teams. The systematic review highlights that both preoperative and postoperative interventions significantly influence patient outcomes, functional recovery, and complication rates. Preoperative assessment and risk stratification are essential, allowing clinicians to identify comorbidities, optimize patient condition, and design individualized care plans. Nurses play a crucial role in this phase, providing patient and family education, reducing anxiety, and ensuring adherence to preoperative protocols, which collectively contribute to safer surgical experiences.

Medication management emerges as a critical component of care. Neurological patients often rely on disease-specific medications such as antiepileptic’s, anticoagulants, or dopaminergic agents, requiring careful adjustment to balance efficacy with safety. Mismanagement can lead to severe complications, including seizures, hemorrhage, or deterioration in neurological function. Nursing involvement in monitoring medication administration, recognizing adverse effects, and educating patients ensures continuity and safety in pharmacological care.

Intraoperative management, including anesthetic choices and monitoring strategies, directly impacts neurological outcomes. Techniques such as TIVA, awake craniotomy, and neurophysiological monitoring provide real-time feedback, minimizing risks of intraoperative neurological compromise. Nurses facilitate these strategies by ensuring accurate documentation, anticipating equipment needs, and supporting anesthesia and surgical teams.

Postoperative care is equally critical, encompassing vigilant neurological and systemic monitoring, early identification of complications, and management of pain, sedation, nutrition, and dysphagia. Disease-specific care plans, tailored to conditions such as stroke, brain tumors, or spinal cord injuries, guide interventions and rehabilitation. Early mobilization, physical and occupational therapy, and structured discharge planning promote functional recovery and reduce hospital readmissions. Nurses are central to this process, bridging clinical management with patient-centered care through continuous monitoring, education, and coordination of interdisciplinary interventions.

Finally, the implementation of ERAS (Enhanced Recovery After Surgery) pathways in neurosurgical and spine surgery demonstrates a systematic approach to improving outcomes, emphasizing preoperative optimization, minimally invasive techniques, multimodal analgesia, and early rehabilitation. The evidence suggests that integrating these protocols enhances recovery, minimizes complications, and improves patient satisfaction.

In conclusion, comprehensive medical and nursing care in the pre- and post-operative periods is vital for neurological surgical patients. The combination of individualized assessment, vigilant monitoring, targeted interventions, patient and family education, and structured rehabilitation ensures optimized clinical outcomes. Future research should focus on standardizing care protocols, evaluating the effectiveness of educational and monitoring interventions, and integrating innovative approaches to further improve patient safety, functional recovery, and quality of life in neurological surgery.

Disclosure Statement

No potential conflict of interest reported by the authors.

 Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

 Authors' Contributions

All authors contributed to data analysis, drafting, and revising of the paper and agreed to be responsible for all the aspects of this work.